Antegrade intramedullary nailing in proximal humeral fractures: results of 23 cases

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Francesco Pogliacomi
Giovanni Malagutti
Margherita Menozzi
Alessandra Colacicco
Francesco Ceccarelli
Enrico Vaienti
Filippo Calderazzi


proximal humerus, fracture, nailing, trauma


Introduction: the metaepiphyseal fractures of the proximal humerus represent 5% of all fractures
and mainly affect elderly patients. The type of treatment remain controversial. This retrospective study aimed
to evaluate the clinic and radiographic results of 23 patients affected by two or three fragments fractures of
the proximal humerus with or without metaphyseal extension treated with antegrade intramedullary nailing.
Materials and Methods: all patients were clinically evaluated using the “Constant score” (CS) and individual
satisfaction was assessed with a visual scale (VS). Moreover, the fracture’s healing process and the neck shaft
angle (NSA) were assessed radiographically. Results: the mean follow-up was 72 months (24-120). Clinical
evaluation and individual satisfaction were positive in most cases (mean CS 79,39 and VS 3,17). Worse results
were observed in patients over 65 years. Discussion: among the different surgical options intramedullary nailing ensures good fracture stability and high consolidation rate. The entry point through the rotator cuff is of
main importance as well as proximal nail positioning and choice of the locking screws length. In this study
the functional results of the shoulder are worse in the elderly, who are supposed to have already a degenerated
rotator cuff. Conclusions: antegrade intramedullary nailing should be considered a valid therapeutic option in
this type of fractures. The surgical technique may influence functional results, as consequence of iatrogenic
damage of the rotator cuff.


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